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Assessing Risk of Developing Heart Artery Disease
- Major risk factors
- Are additional tests helpful as a checkup if one has not had a heart attack or angina?
- CT calcium scores- can be helpful as part of a routine checkup.
- Questions that can arise after a family member has an unexpected heart attack.
- Heart artery disease in families
How can one estimate the future risk of problems due to heart artery disease?
A number of large population studies have identified a number of factors that increase the risk of heart artery disease. The Framingham Study Group in the USA has made a large contribution.
The INTERHEART group has published their landmark findings- revealing the importance of the established risk factors in different population groups.
Read this link for information on major risk factors
After assessment of risk factors, are additional tests helpful?
Many persons are inclined to want additional tests, such as a treadmill test. There will always be instances where a treadmill test result was unexpectedly poor, and lead to the identification of severe artery problems.
Despite these anecdotal reports, most guidelines do not recommend routine use of additional testing. The "cost effectiveness" of additional testing is not proven. In other words, the additional cost of testing has not been shown to be balanced by the potential benefits.
Additional testing can also give uncertain results- in other words the results may not be conclusively normal or abnormal- even further testing is required to clarify the situation increasing costs even more.
Some have suggested that routine testing with treadmill testing is helpful in men aged over fifty years- this suggestion remains a matter for debate.
When might additional tests be of assistance?
Additional testing is necessary for the assessment of symptoms that might be due to heart artery disease.
Additional testing is often considered by some to be necessary to give reassurance to those with chest pain even if it is unlikely there is significant heart artery disease.
Questions that are often asked after a friend or relative has a heart attack unexpectedly.
Using assessment of risk factors one can estimate the risk of future problems with heart artery disease. Persons can be classified as having a "low risk", "moderate risk", "moderate to high risk", or at "high risk".
Simply providing persons with an estimate of their future risk, sometimes is not sufficient to allay anxiety- some persons are keen on further testing.
Is a treadmill test useful just for a checkup even if one does not have any symptoms of heart artery disease?
A treadmill test is often used in this situation, and will continue to be useful in providing reassurance.
Treadmill testing can sometimes provide unexpectedly abnormal results in patients with no symptoms. Some of these patients are found to have unexpectedly advanced disease of the heart arteries.
However, it is much more likely that an abnormal treadmill test will be an incorrect finding, when used in person at low-risk of having significant artery problems. This is termed a "false positive test".
Further testing often reveals the treadmill result to be incorrect. One such test is a heart angiogram test- there is concern of exposing patients to the very small risks of serious complications that can sometimes occur.
Instead of a heart angiogram test a stress echocardiogram test can often provide the necessary reassurance.
What about special X-rays of the heart using a CT scanner?
With the advent of fast CT scanners, an angiogram picture of the heart arteries can be obtained.
In those without any hint of heart artery problems, a limited CT scan looking for calcium deposits in the heart arteries can be useful and might be, arguably, better than a treadmill test in many situations. The amount of calcium in the heart arteries is assessed, and a "calcium score" obtained.
Dr Hitesh Patel, Cardiologist
April, 2007